HIV-1 drug mutations in children from northern Tanzania

Objectives: In resource-limited settings, it is a challenge to get quality clinical specimens due to poor infrastructure for their collection, transportation, processing and storage. Using dried blood spots (DBS) might be an alternative to plasma for HIV-1 drug resistance testing in this setting. The objectives of this study were to determine mutations associated with antiretroviral resistance among children 400 copies/mL. Results: Genotypic resistance mutations were detected in 13 of 46 children (28%). HIV-1 genotypes were A1 (n = 27), C (n = 10), A/D (n = 4), D (n = 3) and CRF10_CD (n = 2). The median age was 12 weeks (IQR 6–28). The mean log10 viral load was 3.87 copies/mL (SD 0.995). All major mutations were detected in the reverse transcriptase gene and none in the protease gene region. The most frequent mutations were Y181C (n = 8) and K103N (n = 4), conferring resistance to non-nucleoside reverse transcriptase inhibitors. Conclusions: One-third of infants newly diagnosed with HIV in northern Tanzania harboured major drug resistance mutations to currently used antiretroviral regimens. These mutations were detected from DBS collected from the field and stored at room temperature. Surveillance of drug resistance among this population in resource-limited settings is warranted

HIV-1 drug mutations in children from northern Tanzania

Objectives: In resource-limited settings, it is a challenge to get quality clinical specimens due to poor infrastructure for their collection, transportation, processing and storage. Using dried blood spots (DBS) might be an alternative to plasma for HIV-1 drug resistance testing in this setting. The objectives of this study were to determine mutations associated with antiretroviral resistance among children 400 copies/mL. Results: Genotypic resistance mutations were detected in 13 of 46 children (28%). HIV-1 genotypes were A1 (n = 27), C (n = 10), A/D (n = 4), D (n = 3) and CRF10_CD (n = 2). The median age was 12 weeks (IQR 6–28). The mean log10 viral load was 3.87 copies/mL (SD 0.995). All major mutations were detected in the reverse transcriptase gene and none in the protease gene region. The most frequent mutations were Y181C (n = 8) and K103N (n = 4), conferring resistance to non-nucleoside reverse transcriptase inhibitors. Conclusions: One-third of infants newly diagnosed with HIV in northern Tanzania harboured major drug resistance mutations to currently used antiretroviral regimens. These mutations were detected from DBS collected from the field and stored at room temperature. Surveillance of drug resistance among this population in resource-limited settings is warranted

One Size Does Not Fit All: Discharge Teaching and Child Challenging Behaviors

This study compares quality of discharge teaching and care coordination for parents of children with challenging behaviors participating in a nursing implementation project, which used an interactive iPad application, to usual discharge care. Unlike parents in the larger quasi-experimental longitudinal project, parents of children with challenging behaviors receiving the discharge teaching application (n = 14) reported lower mean scores on the quality of discharge teaching scale–delivery subscale (M = 8.2, SD = 3.1) than parents receiving usual care (n = 11) (M = 9.6, SD = 4.7) and lower scores on the Care Transition Measure (M = 2.44, SD = 1.09) than parents receiving usual care (M = 3.02, SD = 0.37), with moderate to large effects (0.554–0.775). The discharge teaching approach was less effective with this subset, suggesting other approaches might be considered for this group of parents. Further study with a larger sample specific to parents of children with challenging behaviors is needed to assess their unique needs and to optimize their discharge experience

Using the Engaging Parents in Education for Discharge (\u3cem\u3ee\u3c/em\u3ePED) iPad Application to Improve Parent Discharge Experience

Purpose The purpose of this study was to evaluate the use of the Engaging Parents in Education for Discharge (ePED) iPad application on parent experiences of hospital discharge teaching and care coordination. Hypotheses were: parents exposed to discharge teaching using ePED will have 1) higher quality of discharge teaching and 2) better care coordination than parents exposed to usual discharge teaching. The secondary purpose examined group differences in the discharge teaching, care coordination, and 30-day readmissions for parents of children with and without a chronic condition. Design/Methods Using a quasi-experimental design, ePED was implemented on one inpatient unit (n = 211) and comparison group (n = 184) from a separate unit at a pediatric academic medical center. Patient experience outcome measures collected on day of discharge included Quality of Discharge Teaching Scale-Delivery (QDTS-D) and care coordination measured by Care Transition Measure (CTM). Thirty-day readmission was abstracted from records. Results Parents taught using ePED reported higher QDTS-D scores than parents without ePED (p = .002). No differences in CTM were found between groups. Correlations between QDTS-D and CTM were small for ePED (r = 0.14, p 0.03) and non-ePED (r = 0.29, p \u3c .001) parent groups. CTM was weakly associated with 30-day readmissions in the ePED group. Conclusion The use of ePED by the discharging nurse enhances parent-reported quality of discharge teaching. Practice implications The ePED app is a theory-based structured conversation guide to engage parents in discharge preparation. Nursing implementation of ePED contributes to optimizing the patient/family healthcare experience

Engaging Parents in Education for Discharge (\u3cem\u3ee\u3c/em\u3ePED): Evaluating the Reach, Adoption & Implementation of an Innovative Discharge Teaching Method

Purpose This paper describes the evaluation of the implementation of an innovative teaching method, the “Engaging Parents in Education for Discharge” (ePED) iPad application (app), at a pediatric hospital. Design and methods The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to guide the evaluation. Three of the five RE-AIM elements are addressed in this study: Reach, Adoption, and Implementation. Results The Reach of the ePED was 245 of 1015 (24.2%) patient discharges. The Adoption rate was 211 of 245 (86%) patients discharged in the five months\u27 study period. High levels of fidelity (89.3%) to Implementation of the ePED were attained: the Signs and Symptoms domain had the highest (93%) and Thinking Forward about Family Adjustment screen had the lowest fidelity (83.3%). Nurse themes explained implementation fidelity: “It takes longer”, and “Forgot to do it.” Conclusions The ePED app operationalized how to have an engaging structured discharge conversation with parents. While the Reach of the ePED app was low under the study conditions, the adoption rate was positive. Nurses were able to integrate a theory-driven practice change into their daily routine when using the ePED app. Implications for practice The rates of adoption and implementation fidelity support the feasibility of future hospital wide implementation to improve patient and family healthcare experience. Attention to training of new content and the interactive conversation approach will be needed to fully leverage the value of the ePED app. Future studies are needed to evaluate the maintenance of the ePED app

The R-Process Alliance: Discovery of a Low-α, r-process-enhanced Metal-poor Star in the Galactic Halo

A new moderately r-process-enhanced metal-poor star, RAVE J093730.5−062655, has been identified in the Milky Way halo as part of an ongoing survey by the R-Process Alliance. The temperature and surface gravity indicate that J0937−0626 is likely a horizontal branch star. At [Fe/H] = −1.86, J0937−0626 is found to have subsolar [X/Fe] ratios for nearly every light, α, and Fe-peak element. The low [α/Fe] ratios can be explained by an ~0.6 dex excess of Fe; J0937−0626 is therefore similar to the subclass of "iron-enhanced" metal-poor stars. A comparison with Milky Way field stars at [Fe/H] = −2.5 suggests that J0937−0626 was enriched in material from an event, possibly a Type Ia supernova, that created a significant amount of Cr, Mn, Fe, and Ni and smaller amounts of Ca, Sc, Ti, and Zn. The r-process enhancement of J0937−0626 is likely due to a separate event, which suggests that its birth environment was highly enriched in r-process elements. The kinematics of J0937−0626, based on Gaia DR2 data, indicate a retrograde orbit in the Milky Way halo; J0937−0626 was therefore likely accreted from a dwarf galaxy that had significant r-process enrichment

The RAVE survey: constraining the local Galactic escape speed

We report new constraints on the local escape speed of our Galaxy. Our analysis is based on a sample of high-velocity stars from the RAVE survey and two previously published data sets. We use cosmological simulations of disc galaxy formation to motivate our assumptions on the shape of the velocity distribution, allowing for a significantly more precise measurement of the escape velocity compared to previous studies. We find that the escape velocity lies within the range 498 < vesc < 608 km s−1 (90 per cent confidence), with a median likelihood of 544 km s−1. The fact that v2esc is significantly greater than 2v2circ (where vcirc= 220 km s−1 is the local circular velocity) implies that there must be a significant amount of mass exterior to the solar circle, that is, this convincingly demonstrates the presence of a dark halo in the Galaxy. We use our constraints on vesc to determine the mass of the Milky Way halo for three halo profiles. For example, an adiabatically contracted NFW halo model results in a virial mass of 1.42+1.14−0.54× 1012 M⊙ and virial radius of (90 per cent confidence). For this model the circular velocity at the virial radius is 142+31−21 km s−1. Although our halo masses are model dependent, we find that they are in good agreement with each othe

Event-based record linkage in health and aged care services data: a methodological innovation

<p>Abstract</p> <p>Background</p> <p>The interface between acute hospital care and residential aged care has long been recognised as an important issue in aged care services research in Australia. However, existing national data provide very poor information on the movements of clients between the two sectors. Nevertheless, there are national data sets which separately contain data on individuals' hospital episodes and stays in residential aged care, so that linking the two data sets–if feasible–would provide a valuable resource for examining relationships between the two sectors. As neither name nor common person identifiers are available on the data sets, other information needs to be used to link events relating to inter-sector movement.</p> <p>Methods</p> <p>Event-based matching using limited demographic data in conjunction with event dates to match events in two data sets provides a possible method for linking related events. The authors develop a statistical model for examining the likely prevalence of false matches, and consequently the number of true matches, among achieved matches when using anonymous event-based record linkage to identify transition events.</p> <p>Results</p> <p>Theoretical analysis shows that for event-based matching the prevalence of false matches among achieved matches (a) declines as the events of interest become rarer, (b) declines as the number of matches increases, and (c) increases with the size of the population within which matching is taking place. The method also facilitates the examination of the trade-off between false matches and missed matches when relaxing or tightening linkage criteria.</p> <p>Conclusion</p> <p>Event-based record linkage is a method for linking related transition events using event dates and basic demographic variables (other than name or person identifier). The likely extent of false links among achieved links depends on the two event rates, the match rate and population size. Knowing these, it is possible to gauge whether, for a particular study, event-based linkage could provide a useful tool for examining movements. Analysis shows that there is a range of circumstances in which event-based record linkage could be applied to two event-level databases to generate a linked database useful for transition analysis.</p

The sixth data release of the Radial Velocity Experiment (RAVE). I. Survey description, spectra and radial velocities

The Radial Velocity Experiment (RAVE) is a magnitude-limited (9<I<12) spectroscopic survey of Galactic stars randomly selected in the southern hemisphere. The RAVE medium-resolution spectra (R~7500) cover the Ca-triplet region (8410-8795A). The 6th and final data release (DR6 or FDR) is based on 518387 observations of 451783 unique stars. RAVE observations were taken between 12 April 2003 and 4 April 2013. Here we present the genesis, setup and data reduction of RAVE as well as wavelength-calibrated and flux-normalized spectra and error spectra for all observations in RAVE DR6. Furthermore, we present derived spectral classification and radial velocities for the RAVE targets, complemented by cross matches with Gaia DR2 and other relevant catalogs. A comparison between internal error estimates, variances derived from stars with more than one observing epoch and a comparison with radial velocities of Gaia DR2 reveals consistently that 68% of the objects have a velocity accuracy better than 1.4 km/s, while 95% of the objects have radial velocities better than 4.0 km/s. Stellar atmospheric parameters, abundances and distances are presented in subsequent publication. The data can be accessed via the RAVE Web (http://rave-survey.org) or the Vizier database.Comment: 32 pages, 11 figures, accepted for publication to A

The r-process alliance: First release from the Northern search for r-process enhanced metal-poor stars in the Galactic Halo

This paper presents the detailed abundances and r-process classifications of 126 newly identified metal-poor stars as part of an ongoing collaboration, the R-Process Alliance